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Lai KY, Lee CY, Chang YC, Liu K, Takeuchi M, Yang LT, Ho YL. Prognostic value of fully-automated left atrial strain in patients with asymptomatic chronic severe aortic regurgitation. Int J Cardiol 2024; 416:132487. [PMID: 39209033 DOI: 10.1016/j.ijcard.2024.132487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/29/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND To examine whether left atrial (LA) strain was associated with adverse outcomes in asymptomatic chronic aortic regurgitation (AR). METHODS Asymptomatic patients with ≥moderate-severe AR were retrospectively identified from 2008 through 2022 from a university hospital. Apical 4-chamber left ventricular longitudinal strain (A4C-LVLS), LA reservoir (LASr), conduit (LAScd), and contractile strain (LASct) were measured using fully-automated software. Primary endpoint was all-cause death (ACD); secondary endpoints were heart failure (HF) development or aortic valve surgery (AVS). RESULTS Of 352 patients (59 ± 17 years; 19 % female), the mean LV ejection fraction (LVEF) was 60 ± 8 %. The median follow-up during medical surveillance was 4.7 (interquartile range: 1.8-9.0) years; during which 68 patients died. Multivariable analysis adjusted for covariates showed that larger maximal LA volume index (iLAVmax), lower LASr and LASct were independently associated with ACD (all P ≤ 0.047); A4C-LVLS and LAScd were not (P ≥ 0.15). Besides, iLAVmax, LASr, and LASct provided incremental prognostic value over A4C-LVLS in terms of ACD (all P ≤ 0.048). HF symptoms occurred in 126 patients at a median of 2 years. Multivariable determinants for HF development included larger minimal LAV index, lower LASr and LASct (all P ≤ 0.03). Adjusted spline curves showed LASr <38-40 % and LASct <20-24 % were associated with increased risks of ACD and HF development, respectively. Using abovementioned LASr and LASct cutoffs, adjusted Kaplan-Meier curves risk-stratified patients for ACD successfully (P ≤ 0.02). Lower LASr was also independently associated with AVS (Hazard ratio per 1 % increase: 0.98)(P = 0.02). CONCLUSIONS In patients with asymptomatic AR, fully-automated LASr and LASct were robust markers for outcome determination; these markers may identify those who need timely surgical referral.
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Affiliation(s)
- Kuan-Yu Lai
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Yen Lee
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Ching Chang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kang Liu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Li-Tan Yang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yi-Lwun Ho
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
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Prognostic Value of Preprocedural LV Global Longitudinal Strain for Post-TAVR-Related Morbidity and Mortality: A Meta-Analysis. JACC Cardiovasc Imaging 2023; 16:332-341. [PMID: 36889849 DOI: 10.1016/j.jcmg.2023.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/26/2022] [Accepted: 01/03/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) demonstrates limited prognostic value for post-transcatheter aortic valve replacement (TAVR) outcomes. Evidence regarding the potential role of left ventricular global longitudinal strain (LV-GLS) in this setting is inconsistent. OBJECTIVES The aim of this systematic review and meta-analysis of aggregated data was to evaluate the prognostic value of preprocedural LV-GLS for post-TAVR-related morbidity and mortality. METHODS The authors searched PubMed, Embase, and Web of Science for studies investigating the association between preprocedural 2-dimensional speckle-tracking-derived LV-GLS and post-TAVR clinical outcomes. An inversely weighted random effects meta-analysis was adopted to investigate the association between LV-GLS vs primary (ie, all-cause mortality) and secondary (ie, major cardiovascular events [MACE]) post-TAVR outcomes. RESULTS Of the 1,130 identified records, 12 were eligible, all of which had a low-to-moderate risk of bias (Newcastle-Ottawa scale). On average, 2,049 patients demonstrated preserved LVEF (52.6% ± 1.7%), but impaired LV-GLS (-13.6% ± 0.6%). Patients with a lower LV-GLS had a higher all-cause mortality (pooled HR: 2.01; 95% CI: 1.59-2.55) and MACE (pooled odds ratio [OR]: 1.26; 95% CI: 1.08-1.47) risk compared with patients with higher LV-GLS. In addition, each percentage point decrease of LV-GLS (ie, toward 0%) was associated with an increased mortality (HR: 1.06; 95% CI: 1.04-1.08) and MACE risk (OR: 1.08; 95% CI: 1.01-1.15). CONCLUSIONS Preprocedural LV-GLS was significantly associated with post-TAVR morbidity and mortality. This suggests a potential clinically important role of pre-TAVR evaluation of LV-GLS for risk stratification of patients with severe aortic stenosis. (Prognostic value of left ventricular global longitudinal strain in patients with aortic stenosis undergoing Transcatheter Aortic Valve Implantation: a meta-analysis; CRD42021289626).
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Kang HU, Nam JS, Kim JH, Chin JH, Choi IC. Incremental Prognostic Value of Left Ventricular Longitudinal Strain Over Ejection Fraction in Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2022; 36:4305-4312. [PMID: 36155715 DOI: 10.1053/j.jvca.2022.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate the incremental prognostic value of longitudinal strain over left ventricular ejection fraction (LVEF) after coronary artery bypass grafting (CABG). DESIGN Retrospective cohort study. SETTING Single tertiary-care center. PARTICIPANTS Patients underwent isolated CABG between January 2014 and December 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 999 patients (median age, 65 years, 23.5% female) categorized into 3 groups according to their left ventricular (LV) systolic function status: pEF/pS (preserved LVEF and preserved longitudinal strain, n = 490), pEF/iS (preserved LVEF and impaired longitudinal strain, n = 186), and rEF (reduced LVEF, n = 323). During a median follow-up of 2.7 years, 86 (8.6%) patients had died. The 5-year survival significantly differed in patients with preserved LVEF according to the strain status (pEF/pS v pEF/iS, 90.0% v 84.6%; p = 0.002). After adjusting for potential confounders, the pEF/iS group (adjusted hazard ratio [HR], 2.17; 95% CI, 1.10-4.28; p = 0.03) and the rEF group (adjusted HR, 2.96; 95% CI, 1.46-6.00; p = 0.003) had significantly higher risks for all-cause death compared with the pEF/pS group. The addition of longitudinal strain to LVEF in the prediction model significantly improved its performance (global chi-squared, 105.2 v 110.2; p = 0.03). CONCLUSIONS Left ventricular longitudinal strain could differentiate the prognosis after CABG in patients with preserved LVEF and provide significant incremental prognostic value to LVEF.
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Affiliation(s)
- Hyun-Uk Kang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Sik Nam
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Ji-Hyeon Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji-Hyun Chin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Cheol Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Chacko L, Karia N, Venneri L, Bandera F, Dal Passo B, Buonamici L, Lazari J, Ioannou A, Porcari A, Patel R, Razvi Y, Brown J, Knight D, Martinez-Naharro A, Whelan C, Quarta CC, Manisty C, Moon J, Rowczenio D, Gilbertson JA, Lachmann H, Wechelakar A, Petrie A, Moody WE, Steeds RP, Potena L, Riefolo M, Leone O, Rapezzi C, Hawkins PN, Gillmore JD, Fontana M. Progression of echocardiographic parameters and prognosis in ATTR cardiac amyloidosis. Eur J Heart Fail 2022; 24:1700-1712. [PMID: 35779241 PMCID: PMC10108569 DOI: 10.1002/ejhf.2606] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/08/2022] Open
Abstract
AIMS Transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly diagnosed disease. Echocardiography is widely utilized, but studies to confirm the value of echocardiography for tracking changes over time are not available. We sought to describe: (1) changes in multiple echocardiographic parameters; (2) differences in rate of progression of three predominant genotypes; and (3) the ability of changes in echocardiographic parameters to predict prognosis. METHODS AND RESULTS We prospectively studied 877 ATTR-CM patients attending our centre between 2000 and 2020. Serial echocardiography findings at baseline, 12-months and 24-months were compared with survival. Five-hundred-and-sixty-five patients had wild-type ATTR-CM and 312 hereditary ATTR-CM (201 with V122I; 90 with T60A).There was progressive worsening of structural and functional parameters over time, patients with V122I ATTR-CM showing more rapid worsening of left and right ventricular structural and functional parameters compared to both wild-type and T60A ATTR-CM. Among a wide range of echocardiographic analyses, including deformation-based parameters, only worsening in the degree of mitral and tricuspid regurgitation (MR and TR) at 12-and 24 month assessments was associated with worse prognosis (change at 12-months: MR, hazard ratio 1.43 (1.14-1.80,p=0.002); TR, hazard ratio 1.38 (1.10-1.75,p=0.006). Worsening in MR remained independently associated with poor prognosis after adjusting for known predictors. CONCLUSION In ATTR-CM, echocardiographic parameters progressively worsen over time. Patients with V122I ATTR-CM demonstrate the most rapid deterioration. Worsening of MR and TR were the only parameters associated with mortality, MR remaining independent after adjusting for known predictors. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Liza Chacko
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Nina Karia
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Lucia Venneri
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Francesco Bandera
- Heart Failure Unit, Cardiology University Department, IRCCS Policlinico San Donato, Piazza Malan, 1, San Donato Milanese, Milan, 20097, Italy.,Department for Biomedical Sciences for Health, University of Milano, Via Luigi, Mangiagalli, 31, Milan, 20133, Italy
| | - Beatrice Dal Passo
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Lodovico Buonamici
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Jonathan Lazari
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Adam Ioannou
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Aldostefano Porcari
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Rishi Patel
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Yousuf Razvi
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - James Brown
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Daniel Knight
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Carol Whelan
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Candida C Quarta
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Charlotte Manisty
- Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit, and the Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - James Moon
- Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit, and the Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Dorota Rowczenio
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Janet A Gilbertson
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Helen Lachmann
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Ashutosh Wechelakar
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Aviva Petrie
- Eastman Dental Institute, University College London, Grays Inn Road, London, WC1X 8LD, UK
| | - William E Moody
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, B15 2TH, UK
| | - Richard P Steeds
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, B15 2TH, UK
| | - Luciano Potena
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mattia Riefolo
- Division of Pathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ornella Leone
- Division of Pathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Claudio Rapezzi
- Cardiologic Center, University of Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Philip N Hawkins
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Julian D Gillmore
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Marianna Fontana
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
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Bufano G, Radico F, D'Angelo C, Pierfelice F, De Angelis MV, Faustino M, Pierdomenico SD, Gallina S, Renda G. Predictive Value of Left Atrial and Ventricular Strain for the Detection of Atrial Fibrillation in Patients With Cryptogenic Stroke. Front Cardiovasc Med 2022; 9:869076. [PMID: 35548437 PMCID: PMC9081328 DOI: 10.3389/fcvm.2022.869076] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background and Aims Cryptogenic stroke (CS) is associated with a high rate of recurrences and adverse outcomes at long-term follow-up, especially due to its unknown etiology that often leads to ineffective secondary prevention. Asymptomatic atrial fibrillation (AF) could play an important pathophysiological role. Some studies have pointed to left atrial (LA) and left ventricular (LV) systolic and diastolic dysfunction as surrogate markers of AF. The aim of the study is to evaluate the relationship between echocardiographic parameters of LA and LV function, and the occurrence of AF revealed by continuous ECG monitoring in a cohort of patients with CS. Methods Single-center prospective cohort study. Seventy-two patients with CS with insertable cardiac monitors (ICM) underwent transthoracic echocardiography (TTE). TTE was focused on LA and LV function, including both standard and longitudinal strain-derived parameters. All detected AF episodes lasting more than 2 min were considered. Results Continuous ECG monitoring revealed subclinical AF in 23 patients (32%) at an average of 6.5 months after ICM implantation. Many echocardiographic parameters, indicating LA volume and LV systolic/diastolic function, were significantly associated with the occurrence of AF, suggesting the worst atrial function in the AF group. Furthermore, multivariable regression analysis revealed that peak atrial contraction strain and left ventricular strain were independently associated with AF (adjusted OR = 0.72, CI 95% 0.48–0.90, p = 0.005, and adjusted OR = 0.69, CI 95% 0.46–0.95, p = 0.041, respectively). Conclusion In patients with CS, LA and LV strain analysis add predictive value for the occurrence of AF over clinical and morpho-functional echocardiographic parameters. Impaired booster pump strain and LV longitudinal strain are strong and independent predictors of AF.
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Affiliation(s)
- Gabriella Bufano
- Department of Innovative Technologies in Medicine & Dentistry, Institute of Cardiology, G. d'Annunzio University Chieti-Pescara, Chieti, Italy
| | | | | | - Francesca Pierfelice
- Department of Innovative Technologies in Medicine & Dentistry, Institute of Cardiology, G. d'Annunzio University Chieti-Pescara, Chieti, Italy
| | | | | | - Sante Donato Pierdomenico
- Department of Innovative Technologies in Medicine & Dentistry, Institute of Cardiology, G. d'Annunzio University Chieti-Pescara, Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Cardiology, G. d'Annunzio University Chieti-Pescara, Chieti, Italy
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Cardiology, G. d'Annunzio University Chieti-Pescara, Chieti, Italy
- *Correspondence: Giulia Renda
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Wang Y, Zhang M, Chen H, Li H. Prognostic Value of Global Longitudinal Strain in Asymptomatic Aortic Stenosis: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:778027. [PMID: 35252381 PMCID: PMC8894446 DOI: 10.3389/fcvm.2022.778027] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
Backgrounds The presence of impaired global longitudinal strain (GLS) may be a valuable bio-marker in the early diagnosis for left ventricle (LV) impairment, which would help scrutinize asymptomatic aortic stenosis (AS) patients with high risk of adverse outcomes, such as major adverse cardiovascular events (MACE). Methods The study was prospectively registered in PROPSERO (CRD 42021223472). Databases, such as Pubmed, Embase, Cochrane Library, Web of science, and Scopus were searched for studies evaluating the impact of impaired GLS on MACE, all-cause mortality, and aortic valve replacement (AVR) in asymptomatic AS. Hazard ratios (HRs) with 95% CIs were calculated with meta-analysis for binary variants. Meta-regression, subgroup analysis, and sensitivity analyses were applied as needed to explore the heterogeneity. Results Eventually, a total of nine studies reporting 1,512 patients were enrolled. Compared with the normal GLS group, impaired GLS significantly increased MACE (HR = 1.20, 95% CI: 1.10–1.30, I2 = 79%) with evident heterogeneity, all-cause mortality (HR = 1.42, 95% CI: 1.24–1.63), and AVR (HR = 1.17, 95% CI: 1.07–1.28). Subgroup analyses stratified by left ventricular ejection fraction (LVEF) > 50% or LVEF without precise cut-off point found that compared with the normal GLS group, impaired GLS remarkably increased MACE both in two subgroups (LVEF > 50%: HR: 1.22, 95% CI: 1.05–1.50; LVEF without cutpoint: HR: 1.25, 95% CI: 1.05–1.50). The results stratified by AS severity (mild/moderate and severe) or follow-up time resembled those stratified by LVEF. In addition, when subgroup analysis was stratified by mean aortic valve pressure gradient (MG ≥ 40 mm Hg and MG <40 mm Hg), compared with normal GLS, impaired GLS significantly increased MACE both in two subgroups (MG ≥ 40 mm Hg: HR: 3.41, 95% CI: 1.64–7.09; MG below 40 mm Hg: HR: 3.17, 95% CI: 1.87–5.38). Moreover, the effect sizes here were substantially higher than those in the former two stratified factors. Conclusions The presence of impaired GLS substantially worsens the outcomes for adverse cardiovascular events in asymptomatic patients with AS regardless of LVEF or AS severity or follow-up time or mean aortic valve pressure gradient, which highlights the importance of incorporating impaired GLS into risk algorithms in asymptomatic AS. Systematic Review Registration PROSPERO (registration number: CRD42021223472).
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Cohen OC, Ismael A, Pawarova B, Manwani R, Ravichandran S, Law S, Foard D, Petrie A, Ward S, Douglas B, Martinez-Naharro A, Chacko L, Quarta CC, Mahmood S, Sachchithanantham S, Lachmann HJ, Hawkins PN, Gillmore JD, Fontana M, Falk RH, Whelan CJ, Wechalekar AD. Longitudinal strain is an independent predictor of survival and response to therapy in patients with systemic AL amyloidosis. Eur Heart J 2022; 43:333-341. [PMID: 34472567 DOI: 10.1093/eurheartj/ehab507] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/29/2021] [Accepted: 08/05/2021] [Indexed: 01/28/2023] Open
Abstract
AIMS Cardiac involvement, a major determinant of prognosis in AL (light-chain immunoglobulin) amyloidosis, is characterized by an impairment of longitudinal strain (LS%). We sought to evaluate the utility of LS% in a prospectively observed series of patients. METHODS AND RESULTS A total of 915 serial newly diagnosed AL patients with comprehensive baseline assessments, inclusive of echocardiography, were included. A total of 628/915 (68.6%) patients had cardiac involvement. The LS% worsened with advancing cardiac stage with mean -21.1%, -17.1%, -12.9%, and -12.1% for stages I, II, IIIa, and IIIb, respectively (P < 0.0001). There was a highly significant worsening of overall survival (OS) with worsening LS% quartile: LS% ≤-16.2%: 80 months, -16.1% to -12.2%: 36 [95% confidence interval (CI) 20.9-51.1] months, -12.1% to -9.1%: 22 (95% CI 9.1-34.9) months, and ≥-9.0%: 5 (95% CI 3.2-6.8) months (P < 0.0001). Improvement in LS% was seen at 12 months in patients achieving a haematological complete response (CR) (median improvement from -13.8% to -14.9% in those with CR and difference between involved and uninvolved light chain <10 mg/L). Strain improvement was associated with improved OS (median not reached at 53 months vs. 72 months in patients without strain improvement, P = 0.007). Patients achieving an LS% improvement and a standard N-terminal pro-brain natriuretic peptide-based cardiac response survived longer than those achieving a biomarker-based cardiac response alone (P < 0.0001). CONCLUSION Baseline LS% is a functional marker that correlates with worsening cardiac involvement and is predictive of survival. Baseline LS% and an absolute improvement in LS% are useful additional measures of prognosis and response to therapy in cardiac AL amyloidosis, respectively.
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Affiliation(s)
- Oliver C Cohen
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Andreia Ismael
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Babita Pawarova
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Richa Manwani
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Sriram Ravichandran
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Steven Law
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Darren Foard
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Aviva Petrie
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Sevda Ward
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Brooke Douglas
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Liza Chacko
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | | | - Shameem Mahmood
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | | | - Helen J Lachmann
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Julian D Gillmore
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Rodney H Falk
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Carol J Whelan
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Ashutosh D Wechalekar
- National Amyloidosis Centre, University College London, Rowland Hill Street, London NW3 2PF, UK
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Fukui M, Hashimoto G, Lopes BBC, Stanberry LI, Garcia S, Gössl M, Enriquez-Sarano M, Bapat VN, Sorajja P, Lesser JR, Cavalcante JL. Association of baseline and change in global longitudinal strain by computed tomography with post-transcatheter aortic valve replacement outcomes. Eur Heart J Cardiovasc Imaging 2021; 23:476-484. [PMID: 34791101 DOI: 10.1093/ehjci/jeab229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Transcatheter aortic valve replacement (TAVR) procedural planning requires computed tomography angiography (CTA) which allows for the assessment of left ventricular global longitudinal strain (CTA-LVGLS). There is, however, limited data on the feasibility of CTA-LVGLS, and its prognostic value. This study sought to evaluate the incremental prognostic value of baseline CTA-LVGLS, change in CTA-LVGLS after TAVR, and their association with post-TAVR outcomes. METHODS AND RESULTS A total of 431 patients who underwent multiphasic gated CTA using dual-source system for TAVR planning at baseline and 1-month follow-up were included [median (interquartile range) age, 83 (77-87) years; 44% female, STS-PROM score: 3.3 (2.3-5.1)%, Echo-left ventricular ejection fraction (LVEF): 60 (55-65)%, CTA-LVGLS: -18.0 (-21.6 to -14.2)%, feasible in 97% of patients]. CTA-LVGLS was measured using dedicated feature-tracking software. Over a median follow-up of 19 (13-27) months, 99 endpoints of all-cause death or heart failure hospitalization occurred. The relative hazard of the endpoint increased as baseline CTA-LVGLS worsened with -18.2% as the threshold for higher events (P = 0.005). After adjustment for baseline characteristics, CTA-LVGLS remained associated with the endpoint [hazard ratio (HR) (95% confidence interval, CI), 1.08 (1.03-1.14); P = 0.005] and incrementally improved prognostication (C-index difference, 0.026). Although CTA-LVGLS improved after TAVR [-18.3 (-21.6 to -14.3)% vs. -18.7 (-21.9 to -15.4)%, P < 0.001], patients without CTA-LVGLS improvement had higher risk of the endpoint than those with improvement or preserved baseline global longitudinal strain [HR (95% CI), 1.92 (1.19-3.12); P = 0.008]. CONCLUSIONS In this predominantly low-risk TAVR cohort of patients, mostly with normal LVEF, assessment of CTA-LVGLS is highly feasible improving risk stratification by providing independent and incremental prognostic value over clinical and echocardiographic characteristics.
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Affiliation(s)
- Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 E 28th Street, Suite 100, Minneapolis, MN 55407, USA
| | - Go Hashimoto
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 E 28th Street, Suite 100, Minneapolis, MN 55407, USA
| | - Bernardo B C Lopes
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 E 28th Street, Suite 100, Minneapolis, MN 55407, USA
| | - Larissa I Stanberry
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 E 28th Street, Suite 100, Minneapolis, MN 55407, USA
| | - Santiago Garcia
- Valve Science Center, Minneapolis Heart Institute Foundation, 920 E 28th Street, Minneapolis, MN, 55407, USA.,Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN, 55407, USA
| | - Mario Gössl
- Valve Science Center, Minneapolis Heart Institute Foundation, 920 E 28th Street, Minneapolis, MN, 55407, USA.,Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN, 55407, USA
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, 920 E 28th Street, Minneapolis, MN, 55407, USA.,Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN, 55407, USA
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, 920 E 28th Street, Minneapolis, MN, 55407, USA.,Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN, 55407, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, 920 E 28th Street, Minneapolis, MN, 55407, USA.,Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN, 55407, USA
| | - John R Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, 920 E 28th Street, Minneapolis, MN, 55407, USA.,Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN, 55407, USA
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 E 28th Street, Suite 100, Minneapolis, MN 55407, USA.,Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN, 55407, USA
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9
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Gallard A, Galli E, Hubert A, Bidaut A, Le Rolle V, Smiseth O, Voigt JU, Donal E, Hernández AI. Echocardiographic view and feature selection for the estimation of the response to CRT. PLoS One 2021; 16:e0252857. [PMID: 34111154 PMCID: PMC8191962 DOI: 10.1371/journal.pone.0252857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/25/2021] [Indexed: 11/19/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) is an implant-based therapy applied to patients with a specific heart failure (HF) profile. The identification of patients that may benefit from CRT is a challenging task and the application of current guidelines still induce a non-responder rate of about 30%. Several studies have shown that the assessment of left ventricular (LV) mechanics by speckle tracking echocardiography can provide useful information for CRT patient selection. A comprehensive evaluation of LV mechanics is normally performed using three different echocardioraphic views: 4, 3 or 2-chamber views. The aim of this study is to estimate the relative importance of strain-based features extracted from these three views, for the estimation of CRT response. Several features were extracted from the longitudinal strain curves of 130 patients and different methods of feature selection (out-of-bag random forest, wrapping and filtering) have been applied. Results show that more than 50% of the 20 most important features are calculated from the 4-chamber view. Although features from the 2- and 3-chamber views are less represented in the most important features, some of the former have been identified to provide complementary information. A thorough analysis and interpretation of the most informative features is also provided, as a first step towards the construction of a machine-learning chain for an improved selection of CRT candidates.
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Affiliation(s)
- Alban Gallard
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
| | - Elena Galli
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
| | - Arnaud Hubert
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
| | - Auriane Bidaut
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
| | - Virginie Le Rolle
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
| | - Otto Smiseth
- Center for Cardiological Innovation and Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
- * E-mail:
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10
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Park J, Kim Y, Pereira J, Hennessey KC, Faridi KF, McNamara RL, Velazquez EJ, Hur DJ, Sugeng L, Agarwal V. Understanding the role of left and right ventricular strain assessment in patients hospitalized with COVID-19. ACTA ACUST UNITED AC 2021; 6:100018. [PMID: 34095889 PMCID: PMC8168299 DOI: 10.1016/j.ahjo.2021.100018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 01/07/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) can cause cardiac injury resulting in abnormal right or left ventricular function (RV/LV) with worse outcomes. We hypothesized that two-dimensional (2D) speckle-tracking assessment of LV global longitudinal strain (GLS) and RV free wall strain (FWS) by transthoracic echocardiography can assist as markers for subclinical cardiac injury predicting increased mortality. Methods We performed 2D strain analysis via proprietary software in 48 patients hospitalized with COVID-19. Clinical information, demographics, comorbidities, and lab values were collected via retrospective chart review. The primary outcome was in-hospital mortality based on an optimized abnormal LV GLS value via ROC analysis and RV FWS. Results The optimal LV GLS cutoff to predict death was −13.8%, with a sensitivity of 85% (95% CI 55–98%) and specificity of 54% (95% CI 36–71%). Abnormal LV GLS >-13.8% was associated with a higher risk of death [unadjusted hazard ratio 5.15 (95% CI 1.13–23.45), p = 0.034], which persisted after adjustment for clinical variables. Among patients with LV ejection fraction (LVEF) >50%, those with LV GLS > −13.8% had higher mortality compared to those with LV GLS <-13.8% (41% vs. 10%, p = 0.030). RV FWS value was higher in patients with LV GLS >-13.8% (−13.7 ± 5.9 vs. −19.6 ± 6.7, p = 0.003), but not associated with decreased survival. Conclusion Abnormal LV strain with a cutoff of >−13.8% in patients with COVID-19 is associated with significantly higher risk of death. Despite normal LVEF, abnormal LV GLS predicted worse outcomes in patients hospitalized with COVID-19. There was no mortality difference based on RV strain.
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Key Words
- 2D, Two-dimensional
- ARDS, acute respiratory distress syndrome
- COVID-19
- COVID-19, Coronavirus Disease 2019
- EF, ejection fraction
- FAC, fractional area change
- FWS, free wall strain
- GLS, global longitudinal strain
- HFrEF, heart failure reduced ejection fraction
- Hs-TNT, high sensitivity troponin T
- ICC, intra-class correlation coefficient
- LV, left ventricle
- Left ventricular strain
- NT-proBNP, NT-pro-brain natriuretic peptide
- RV, right ventricle
- Speckle-tracking echocardiography
- TTE, transthoracic echocardiography
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Affiliation(s)
- Jakob Park
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Yekaterina Kim
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jason Pereira
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kerrilynn C Hennessey
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kamil F Faridi
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Robert L McNamara
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Eric J Velazquez
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - David J Hur
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Vratika Agarwal
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
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11
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Karande A. Role of strain imaging for guiding management of valvular heart disease: Current status. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2021. [DOI: 10.4103/jiae.jiae_6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Kitano T, Nabeshima Y, Negishi K, Takeuchi M. Prognostic value of automated longitudinal strain measurements in asymptomatic aortic stenosis. Heart 2020; 107:heartjnl-2020-318256. [PMID: 33318081 DOI: 10.1136/heartjnl-2020-318256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Two-dimensional (2D) longitudinal strain (LS) predicts cardiac events in aortic stenosis (AS). However, it requires manual editing, which affects its accuracy and reliability. We investigated whether left ventricular (LV), left atrial (LA) and right ventricular (RV) LSs using fully automated 2D strain software provide useful prognostic information in asymptomatic AS. METHODS We performed LS analyses in 340 asymptomatic patients with AS using novel, fully automated 2D strain analytical software (AutoStrain, Philips) to obtain LV global LS (LVGLS), LALS, RV free wall LS and RVLS. The primary end point was a composite of cardiac events, including cardiac death, heart failure hospitalisation, myocardial infarction or ventricular tachyarrhythmia. RESULTS During a median of 24 months follow-up, 46 patients reached a primary end point. 62 patients had aortic valve surgery. All four LSs were significantly associated with the primary end point using univariate analysis (HR 0.821 to 0.951, p<0.05). Multivariate analysis revealed that LVGLS (HR 0.873 to 0.888, p<0.05) remained significantly associated with cardiac events, even after adjusting haemodynamic measures of AS severity and LV ejection fraction. Kaplan-Meier survival curve showed median values of both LVGLS (cut-off: 15.1%) and LALS (cut-off: 22.3%) provide a significant difference in cardiac event rate (3-year event-free rate; LVGLS: 89% vs 76%, p=0.002; LALS: 89% vs 76%, p=0.001). Classification and regression-tree analysis, including four LSs, clinical characteristics and traditional echocardiographic parameters, selected LVGLS and E/ε' for stratifying a high-risk group of patients with cardiac events. CONCLUSIONS Fully automated 2D LS analysis, especially LVGLS provides useful prognostic information in asymptomatic AS.
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Affiliation(s)
- Tetsuji Kitano
- Department of Cardiology and Nephrology, Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yosuke Nabeshima
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Kazuaki Negishi
- Nepean Clinical School, Charles Perkins Centre Nepean, The University of Sydney, Penrith, New South Wales, Australia
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Japan
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13
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Prognostic Importance of Left Ventricular Global Longitudinal Strain in Patients with Severe Aortic Stenosis and Preserved Ejection Fraction. J Am Soc Echocardiogr 2020; 33:1454-1464. [DOI: 10.1016/j.echo.2020.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 11/20/2022]
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14
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Ennezat PV, Malergue MC, Le Jemtel TH, Abergel E. Watchful waiting care or early intervention in asymptomatic severe aortic stenosis: Where we are. Arch Cardiovasc Dis 2020; 114:59-72. [PMID: 33153947 DOI: 10.1016/j.acvd.2020.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022]
Abstract
Aortic stenosis, the most common valvular heart disease in Western countries, affects predominantly older people. Prompt aortic valve replacement is undoubtedly indicated in symptomatic patients. Management of asymptomatic patients is nowadays shifting from a conservative approach to early aortic valve replacement, as multimodality imaging is increasingly available. However, multimodality imaging has led to multiple prognostic parameters and complex algorithms, as well as a new staging classification that has left patients and physicians somewhat puzzled. We highlight the value of thorough serial clinical examinations, Doppler echocardiography and exercise testing when caring for a growing aortic stenosis population, including that has no or limited access to multimodality imaging. Evidence for early aortic valve replacement versus conservative management in asymptomatic patients with severe aortic stenosis is biased by the lack of serial stress testing evaluation; 30% of so-called asymptomatic patients were in fact symptomatic, and thus were clear candidates for aortic valve replacement in the above-mentioned studies. Randomized trials of aortic valve replacement versus conservative management that include serial stress testing evaluation are needed to ascertain whether early aortic valve replacement actually improves clinical outcome in asymptomatic patients with severe aortic stenosis. Less interventional medicine and healthcare resource utilization can result in better health.
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Affiliation(s)
- Pierre Vladimir Ennezat
- Department of cardiology, centre hospitalier universitaire de Grenoble-Alpes, 38700 La Tronche, France
| | | | - Thierry H Le Jemtel
- Section of cardiology, department of medicine, Tulane university school of medicine, Tulane university heart and vascular institute, 70112 New Orleans, LA, USA
| | - Eric Abergel
- Department of cardiology and cardiovascular surgery, clinique Saint-Augustin, 114, avenue d'Ares, 33200 Bordeaux, France.
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15
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Bohbot Y, Renard C, Manrique A, Levy F, Maréchaux S, Gerber BL, Tribouilloy C. Usefulness of Cardiac Magnetic Resonance Imaging in Aortic Stenosis. Circ Cardiovasc Imaging 2020; 13:e010356. [PMID: 32370617 DOI: 10.1161/circimaging.119.010356] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The objective of this review is to provide an overview of the role of cardiac magnetic resonance (CMR) in aortic stenosis (AS). Although CMR is undeniably the gold standard for assessing left ventricular volume, mass, and function, the assessment of the left ventricular repercussions of AS by CMR is not routinely performed in clinical practice, and its role in evaluating and quantifying AS is not yet well established. CMR is an imaging modality integrating myocardial function and disease, which could be particularly useful in a pathology like AS that should be considered as a global myocardial disease rather than an isolated valve disease. In this review, we discuss the emerging potential of CMR for the diagnosis and prognosis of AS. We detail its utility for studying all aspects of AS, including valve anatomy, flow quantification, left ventricular volumes, mass, remodeling, and function, tissue mapping, and 4-dimensional flow magnetic resonance imaging. We also discuss different clinical situations where CMR could be useful in AS, for example, in low-flow low-gradient AS to confirm the low-flow state and to understand the reason for the left ventricular dysfunction or when there is a suspicion of associated cardiac amyloidosis.
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Affiliation(s)
- Yohann Bohbot
- Department of Cardiology (Y.B., C.T.), Amiens University Hospital, France.,UR UPJV 7517, Jules Verne University of Picardie, Amiens, France (Y.B., S.M., C.T.)
| | - Cédric Renard
- Department of Radiology (C.R.), Amiens University Hospital, France
| | - Alain Manrique
- Department of Nuclear Medicine, CHU Cote de Nacre, Normandy University, Caen, France (A.M.)
| | - Franck Levy
- Department of Cardiology, Centre Cardio-Thoracique De Monaco (F.L.)
| | - Sylvestre Maréchaux
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France (Y.B., S.M., C.T.).,Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté libre de médecine, Université Lille Nord de France (S.M.)
| | - Bernhard L Gerber
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (B.L.G.).,Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium (B.L.G.)
| | - Christophe Tribouilloy
- Department of Cardiology (Y.B., C.T.), Amiens University Hospital, France.,UR UPJV 7517, Jules Verne University of Picardie, Amiens, France (Y.B., S.M., C.T.)
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16
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Feature tracking computed tomography-derived left ventricular global longitudinal strain in patients with aortic stenosis: a comparative analysis with echocardiographic measurements. J Cardiovasc Comput Tomogr 2020; 14:240-245. [DOI: 10.1016/j.jcct.2019.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/09/2019] [Accepted: 11/20/2019] [Indexed: 11/23/2022]
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17
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Abstract
Echocardiographic strain imaging allows new insight into a complex cardiac mechanics and enables more precise evaluation of cardiac function. Hence, it has been shown to have clinical utility in a variety of valvular heart diseases. In particular, global longitudinal strain has been shown to be more sensitive to detect systolic dysfunction than left ventricular ejection fraction. In patients with valvular heart diseases, it provides both diagnostic and prognostic information in addition to standard echocardiographic and clinical parameters. In this review, we summarize current clinical application of strain echocardiography in patients with valvular heart diseases and discuss pathophysiological mechanisms that lead to respective findings in specific diseases.
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18
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Chacko L, Martone R, Bandera F, Lane T, Martinez-Naharro A, Boldrini M, Rezk T, Whelan C, Quarta C, Rowczenio D, Gilbertson JA, Wongwarawipat T, Lachmann H, Wechalekar A, Sachchithanantham S, Mahmood S, Marcucci R, Knight D, Hutt D, Moon J, Petrie A, Cappelli F, Guazzi M, Hawkins PN, Gillmore JD, Fontana M. Echocardiographic phenotype and prognosis in transthyretin cardiac amyloidosis. Eur Heart J 2020; 41:1439-1447. [DOI: 10.1093/eurheartj/ehz905] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/01/2019] [Accepted: 12/07/2019] [Indexed: 12/15/2022] Open
Abstract
Abstract
Aims
Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is an increasingly recognized cause of heart failure. We sought to characterize the structural and functional echocardiographic phenotype across the spectrum of wild-type (wtATTR-CM) and hereditary (hATTR-CM) transthyretin cardiomyopathy and the echocardiographic features predicting prognosis.
Methods and results
We studied 1240 patients with ATTR-CM who underwent prospective protocolized evaluations comprising full echocardiographic assessment and survival between 2000 and 2019, comprising 766 with wtATTR-CM and 474 with hATTR-CM, of whom 314 had the V122I variant and 127 the T60A variant. At diagnosis, patients with V122I-hATTR-CM had the most severe degree of systolic and diastolic dysfunction across all echocardiographic parameters and patients with T60AhATTR-CM the least; patients with wtATTR-CM had intermediate features. Stroke volume index, right atrial area index, longitudinal strain, and E/e’ were all independently associated with mortality (P < 0.05 for all). Severe aortic stenosis (AS) was also independently associated with prognosis, conferring a significantly shorter survival (median survival 22 vs. 53 months, P = 0.001).
Conclusion
The three distinct genotypes present with varying degrees of severity. Echocardiography indicates a complex pathophysiology in which both systolic and diastolic function are independently associated with mortality. The presence of severe AS was independently associated with significantly reduced patient survival.
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Affiliation(s)
- Liza Chacko
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Raffaele Martone
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
- Department of Heart, Lung and Vessels, Tuscan Regional Amyloid Center, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy
| | - Francesco Bandera
- Heart Failure Unit, Cardiology University Department, IRCCS Policlinico San Donato, Piazza Malan, 1, San Donato Milanese, Milan 20097, Italy
- Department for Biomedical Sciences for Health, University of Milano, Via Luigi Mangiagalli, 31, Milan 20133, Italy
| | - Thirusha Lane
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Michele Boldrini
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Tamer Rezk
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Carol Whelan
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Cristina Quarta
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Dorota Rowczenio
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Janet A Gilbertson
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Tanakal Wongwarawipat
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Helen Lachmann
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Ashutosh Wechalekar
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Sajitha Sachchithanantham
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Shameem Mahmood
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Daniel Knight
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - David Hutt
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - James Moon
- Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit, and the Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - Aviva Petrie
- Biostatistics Unit, UCL Eastman Dental Institute, University College London, 256 Grays Inn Road, London WC1X 8LD, UK
| | - Francesco Cappelli
- Department of Heart, Lung and Vessels, Tuscan Regional Amyloid Center, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy
| | - Marco Guazzi
- Heart Failure Unit, Cardiology University Department, IRCCS Policlinico San Donato, Piazza Malan, 1, San Donato Milanese, Milan 20097, Italy
- Department for Biomedical Sciences for Health, University of Milano, Via Luigi Mangiagalli, 31, Milan 20133, Italy
| | - Philip N Hawkins
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Julian D Gillmore
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Marianna Fontana
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
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Boldrini M, Cappelli F, Chacko L, Restrepo-Cordoba MA, Lopez-Sainz A, Giannoni A, Aimo A, Baggiano A, Martinez-Naharro A, Whelan C, Quarta C, Passino C, Castiglione V, Chubuchnyi V, Spini V, Taddei C, Vergaro G, Petrie A, Ruiz-Guerrero L, Moñivas V, Mingo-Santos S, Mirelis JG, Dominguez F, Gonzalez-Lopez E, Perlini S, Pontone G, Gillmore J, Hawkins PN, Garcia-Pavia P, Emdin M, Fontana M. Multiparametric Echocardiography Scores for the Diagnosis of Cardiac Amyloidosis. JACC Cardiovasc Imaging 2019; 13:909-920. [PMID: 31864973 DOI: 10.1016/j.jcmg.2019.10.011] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study aimed to investigate the accuracy of a broad range of echocardiographic variables to develop multiparametric scores to diagnose CA in patients with proven light chain (AL) amyloidosis or those with increased heart wall thickness who had amyloid was suspected. We also aimed to further characterize the structural and functional changes associated with amyloid infiltration. BACKGROUND Cardiac amyloidosis (CA) is a serious but increasingly treatable cause of heart failure. Diagnosis is challenging and frequently unclear at echocardiography, which remains the most often used imaging tool. METHODS We studied 1,187 consecutive patients evaluated at 3 referral centers for CA and analyzed morphological, functional, and strain-derived echocardiogram parameters with the aim of developing a score-based diagnostic algorithm. Cardiac amyloid burden was quantified by using extracellular volume measurements at cardiac magnetic resonance. RESULTS A total of 332 patients were diagnosed with AL amyloidosis and 339 patients with transthyretin CA. Concentric remodeling and strain-derived parameters displayed the best diagnostic performance. A multivariable logistic regression model incorporating relative wall thickness, E wave/e' wave ratio, longitudinal strain, and tricuspid annular plane systolic excursion had the greatest diagnostic performance in AL amyloidosis (area under the curve: 0.90; 95% confidence interval: 0.87 to 0.92), whereas the addition of septal apical-to-base ratio yielded the best diagnostic accuracy in the increased heart wall thickness group (area under the curve: 0.80; 95% confidence interval: 0.85 to 0.90). CONCLUSIONS Specific functional and structural parameters characterize different burdens of CA deposition with different diagnostic performances and enable the definition of 2 scores that are sensitive and specific tools with which diagnose or exclude CA.
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Affiliation(s)
- Michele Boldrini
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom; Emergency Department, Internal Medicine Department, Amyloidosis Research and Treatment Center, Istituto di Ricerca a Carattere Clinico e Scientifico Policlinico San Matteo Foundation, Pavia, Italy
| | - Francesco Cappelli
- Tuscan Regional Amyloid Centre, Careggi University Hospital, Florence, Italy
| | - Liza Chacko
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Maria Alejandra Restrepo-Cordoba
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Angela Lopez-Sainz
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Alberto Giannoni
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alberto Aimo
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Ana Martinez-Naharro
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Carol Whelan
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Cristina Quarta
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Claudio Passino
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | | | | | - Giuseppe Vergaro
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Aviva Petrie
- Eastman Dental Institute, University College London, Grays Inn Road, London, United Kingdom
| | - Luis Ruiz-Guerrero
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Vanessa Moñivas
- University Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | | | - Jesus G Mirelis
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Fernando Dominguez
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Esther Gonzalez-Lopez
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Stefano Perlini
- Emergency Department, Internal Medicine Department, Amyloidosis Research and Treatment Center, Istituto di Ricerca a Carattere Clinico e Scientifico Policlinico San Matteo Foundation, Pavia, Italy
| | | | - Julian Gillmore
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Pablo Garcia-Pavia
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain; University Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Michele Emdin
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom.
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20
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Cardiac magnetic resonance-derived right atrial functional analysis in patients with atrial fibrillation and typical atrial flutter. J Interv Card Electrophysiol 2019; 59:381-391. [PMID: 31807985 DOI: 10.1007/s10840-019-00636-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Typical atrial flutter (AFL) often occurs in patients with atrial fibrillation (AF). Decision-making tools for application of prophylactic cavo-tricuspid isthmus (CTI) ablation at the time of AF ablation may improve outcomes. In this study, we sought to define the right atrial (RA) functional characteristics of AF patients with documented typical AFL. METHODS Consecutive patients that underwent cardiac magnetic resonance (CMR) prior to initial AF ablation in the Johns Hopkins Hospital were enrolled. The AF database was reviewed to identify prevalent and incident documented typical AFL. Feature tracking CMR analysis during sinus rhythm was utilized to quantify RA longitudinal strain and strain rate, as well as RA passive and active emptying fractions derived from phasic RA volumes. RESULTS A total of 115 patients were analyzed (mean age 59.1 ± 11.4 years, 78.3% male, 74.8% paroxysmal AF). Of all patients, 30 (26.1%) had typical AFL. Clinical characteristics and AF type did not differ among groups defined by the absence or presence of typical AFL. In contrast, RA longitudinal strain (41.6 ± 16.8% vs. 55.8 ± 17.1%, p ≤ 0.001), systolic strain rate (1.71 ± 0.85 s-1 vs. 2.33 ± 0.93 s-1, p = 0.002), and late diastolic strain rate (1.78 ± 1.02 s-1 vs. 2.50 ± 0.91 s-1 p ≤ 0.001) were significantly lower in patients with typical AFL. Although RA passive emptying fraction was similar among groups (18.9 ± 8.1 vs. 19.5 ± 8.0, p = 0.75), RA active emptying fraction was lower in patients with typical AFL (34.8 ± 12.3 vs. 40.8 ± 12.1, p = 0.02). CONCLUSIONS The reservoir and pump function of the RA is significantly reduced in patients with typical AFL. Prophylactic CTI ablation warrants further study as adjunctive therapy to AF catheter ablation in selected patients with RA dysfunction.
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Park SJ, Dweck MR. Multimodality Imaging for the Assessment of Severe Aortic Stenosis. J Cardiovasc Imaging 2019; 27:235-246. [PMID: 31614393 PMCID: PMC6795563 DOI: 10.4250/jcvi.2019.27.e48] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/29/2019] [Accepted: 07/17/2019] [Indexed: 01/18/2023] Open
Abstract
Aortic stenosis is the most common type of valvular heart disease. Aortic stenosis is characterized both by progressive valve narrowing and the left ventricular remodeling response that ensues. In aortic stenosis, therapeutic decision essentially depends on symptomatic status, stenosis severity, and status of left ventricular systolic function. Imaging is fundamental for the initial diagnostic work-up, follow-up, and selection of the optimal timing and type of intervention. Noninvasive imaging has played a pivotal role in enhancing our understanding of the complex pathophysiology underlying aortic stenosis, as well as disease progression in both the valve and myocardium. The present review provides the application of multimodality imaging in aortic stenosis.
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Affiliation(s)
- Sung Ji Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK
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22
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Vasyuk YA, Nesvetov VV, Yushuk EN, Scherbak MM. [Clinical Capabilities and Limitations in the Use of Modern Technologies in Echocardiography]. ACTA ACUST UNITED AC 2019; 59:68-75. [PMID: 31322092 DOI: 10.18087/cardio.2019.7.2651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 07/19/2019] [Indexed: 11/18/2022]
Abstract
Transthoracic echocardiography is the most frequently used method for detection of impaired contractility of the left ventricle. In most cases, assessment of contractility is carried out visually "by eye", what increases its subjectivity, is operator-dependent in nature and requires a high level of clinical training and experience of the researcher. Currently in the arsenal of a specialist in echocardiography for quantification of left ventricular contractility sometimes is used tissue Doppler echocardiography, however, this method requires special settings of the image (high frame rate, the allocation of zones of interest), depends on the scanning angle and on operator qualification, has high intra - and inter-operator variability, and significantly increases the duration of the study. Therefore, this method has not received wide clinical application. In the 2000s years an innovative technique of speckle tracking emerged, which, unlike tissue Doppler echocardiography is efficient, does not burden a researcher with time costs, has a low intra - and inter- operator variability, does not depend on scan angle. In recent years, this technology is actively implemented in clinical practice for detection of subclinical impairment of the functional state of the myocardium in different diseases and syndromes: arterial hypertension, ischemic heart disease, valvular defects, and congenital heart disease, heart failure, cardiomyopathy of different etiology.
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Affiliation(s)
- Yu A Vasyuk
- A. I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - V V Nesvetov
- A. I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - E N Yushuk
- A. I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - M M Scherbak
- A. I. Yevdokimov Moscow State University of Medicine and Dentistry
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Levy-Neuman S, Meledin V, Gandelman G, Goland S, Zilberman L, Edri O, Shneider N, Abaeh N, Bdolah-Abram T, George J, Shimoni S. The Association Between Longitudinal Strain at Rest and Stress and Outcome in Asymptomatic Patients With Moderate and Severe Aortic Stenosis. J Am Soc Echocardiogr 2019; 32:722-729. [PMID: 30926404 DOI: 10.1016/j.echo.2019.01.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Calcific aortic stenosis (AS) is a progressive disease, and once moderate AS is present, the likelihood of symptom onset within 5 years is significant. The aim of this study was to determine the incremental value of global longitudinal strain (GLS) and basal longitudinal strain (BLS) at rest and during exercise on outcomes among asymptomatic patients' with moderate and severe AS. METHODS Seventy-five patients with isolated, asymptomatic AS and preserved left ventricular function were retrospectively enrolled and underwent symptom-limited exercise echocardiography. Clinical and echocardiographic data, including GLS and BLS at rest and during exercise, were assessed. Occurrence of AS-related cardiovascular events was recorded. RESULTS The mean age was 71 ± 10 years, and 63% were men. The mean aortic valve gradient was 30 ± 11 mm Hg, and the mean aortic valve area was 0.98 ± 0.21 cm2. Resting GLS and BLS were -16.5 ± 4% and -16.9 ± 3.6%, respectively. Exercise stress test results were positive in 27 patients (36%). Mean exercise GLS was -17.8 ± 3.5%, and mean exercise BLS was -17.9 ± 4%. During mean follow-up of 34.5 ± 3.5 months, cardiovascular events were observed in 45 patients. In multivariate analysis, aortic valve mean gradient (HR, 1.073; 95% CI, 1.032-1.115; P < .001) and peak exercise BLS (HR, 1.177; 95% CI, 1.07-1.295; P = .001) were associated with cardiac events during follow-up. CONCLUSIONS Reduced exercise BLS is associated with future cardiovascular events in patients' with asymptomatic AS, independently of clinical factors and conventional echocardiographic parameters. Detection of postexercise myocardial dysfunction in patients with asymptomatic AS with preserved left ventricular function can aid in risk assessment of these patients.
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Affiliation(s)
| | - Valery Meledin
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel
| | - Gera Gandelman
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel
| | - Sorel Goland
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel; Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Liaz Zilberman
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel
| | - Orly Edri
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel
| | | | - Naama Abaeh
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel
| | | | - Jacob George
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel; Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Sara Shimoni
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel; Hebrew University and Hadassah Medical School, Jerusalem, Israel.
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Bohbot Y, de Meester de Ravenstein C, Chadha G, Rusinaru D, Belkhir K, Trouillet C, Pasquet A, Marechaux S, Vanoverschelde JL, Tribouilloy C. Relationship Between Left Ventricular Ejection Fraction and Mortality in Asymptomatic and Minimally Symptomatic Patients With Severe Aortic Stenosis. JACC Cardiovasc Imaging 2019; 12:38-48. [DOI: 10.1016/j.jcmg.2018.07.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/10/2018] [Accepted: 07/27/2018] [Indexed: 10/27/2022]
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25
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Magne J, Cosyns B, Popescu BA, Carstensen HG, Dahl J, Desai MY, Kearney L, Lancellotti P, Marwick TH, Sato K, Takeuchi M, Zito C, Casalta AC, Mohty D, Piérard L, Habib G, Donal E. Distribution and Prognostic Significance of Left Ventricular Global Longitudinal Strain in Asymptomatic Significant Aortic Stenosis. JACC Cardiovasc Imaging 2019; 12:84-92. [DOI: 10.1016/j.jcmg.2018.11.005] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 02/06/2023]
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